North Carolina Medicaid Long Term Care Eligibility for 2025

North Carolina Long Term Care

Eligibility for 2025:

1. Residency and Citizenship – the applicant must be a North Carolina resident and a U.S. citizen or have proper immigration status.

2. Age/Disability – the applicant must be age 65 or older, or blind, or disabled. The applicant must meet certain medical requirements consistent with the level of care requested. Persons must need care for thirty (30) consecutive days.

3. Income Limitations – The applicant’s income must be less than the Medicaid-approved cost of care in the facility, estimated to be between $8,004 / month and $11,093 / month in 2025. If single and medically needy, Medicaid will pay all long-term care costs exceeding the applicant’s countable monthly income. Non-countable income includes:

A personal needs allowance ($70/month per individual)
Health insurance premiums and uncovered medical expenses
Certain spousal or dependent family members’ allowances
A home maintenance allowance if the recipient expects to return home within six months

4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under Medicaid rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not exempt, it must be liquidated and applied toward the costs of nursing home care before Medicaid benefits can begin. North Carolina has a 60-month look-back period to prevent transferring or selling assets below market value.

Assets transferred to a spouse, a blind or disabled child, or specific trusts for disabled individuals may not result in Medicaid ineligibility.

Exempt Assets in 2025 for an applicant in North Carolina include:

$2,000 or less in cash/non-exempt assets if single. If married and both spouses require care, the asset limit is $3,000.
One home is exempt (equity limit $730,000) if planning to return, or if a spouse, a child under 21, or a disabled person resides in it.
One automobile, no equity limit specified. If two or more cars are owned, the most valuable is exempt.
An irrevocable funeral trust with a value of $1,500 or less. Revocable burial contracts are countable unless converted to irrevocable.
Life insurance policies with a combined face value under $10,000.
Household furnishings, personal effects, and other non-saleable property are excluded.
Retirement funds in payout status, including fixed irrevocable annuities.

Spousal Rules for 2025:

Amount of assets a community spouse may retain: The community spouse can retain up to $157,920 in non-exempt assets. If their share of assets is less than $31,584, they may retain additional assets from the institutionalized spouse to meet this minimum.

Community spouse impoverishment protection: The community spouse may retain income from the institutionalized spouse if their income is less than $2,555 per month. With additional housing and utility allowances, the maximum income allowed is $3,948 per month.

North Carolina Long Term Care Insurance Partnership for 2025:

This program protects assets by matching dollar-for-dollar what policyholders pay into their policies. For example, a Partnership Policy with a $155,000 benefit payout allows $155,000 in assets to be exempted for Medicaid eligibility. Both spouses in a married couple must purchase separate policies.